The Accuracy of the Physical Exam versus Arthroscopy in the Detection of Subscapularis Tendon Injury

Abstract

Objectives:The main purpose of this study was to obtain the accuracy of the physical exam in the detection of subscapularis tendon tears and compare it to the gold standard of arthroscopy to determine whether clinical examination can reliably predict the presence of subscapularis tendon tears.Methods:This was a retrospective analysis of 52 patients (52 shoulders) who underwent arthroscopic subscapularis tendon repairs between September 2008 and April 2012. The inclusion criteria for this study were that all patients must have had at least 1 of the 3 screening tests performed prior to arthroscopy, arthroscopic evidence of a subscapularis tear, and subsequent repair of this tear. Exclusion criteria in this study included lack of documentation of screening tests. Positive findings on any combination of the belly press, lift-off, and bear hug tests constituted a positive physical exam resultResults:There was a positive finding on physical exam in 42/52 patients. The sensitivity of the physical exam in the detection of subscapularis tendon injury was found to be 81%. Ten of the 52 patients with subscapularis tendon tears had negative physical exam results (false negatives). The median number of days between the physical exam and arthroscopic confirmation of a subscapularis tendon tear was 16 days.Conclusion:The belly press, lift-off, and bear hug tests can reliably predict subscapularis tendon tears. Consistent implementation of these three components of the physical exam can potentially lead to fewer undetected subscapularis tears, resulting in fewer failed rotator cuff repairs and improved overall post-operative outcomes.